Individual provider Active NPI

Kelly K. Ross Manashil, NP

  • Family Nurse Practitioner
  • Sacramento, CA
National Provider Identifier
1053448043
Registry record updated Jul 21, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Nurse PractitionerTaxonomy code 363LF0000X
License
12842 Issued in CA
Practice address
4501 X St
Sacramento, CA 95817-2229
Phone
(916) 734-5959
Fax
(916) 703-5265
NPI assigned
Feb 27, 2007
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 21, 2022

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Nurse Practitioner 363LF0000X 12842 CA Primary

Addresses

Primary practice location

4501 X St
Sacramento, CA 95817-2229

Mailing address

4501 X St Ste 3016
Sacramento, CA 95817-2229
Phone (916) 734-3772

Other identifiers 1

IdentifierTypeStateIssuer
083477OtherCAACMC PROVIDER NUMBER

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file
Eligible to order & refer
  • Part B services: No
  • Medical equipment: Yes
  • Home health: No
  • Power mobility devices: Yes
  • Hospice: No
Green means eligible to order or refer.

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Regents of the University of Ca CurrentSince Aug 22, 2018 Accepting new patients
Regents of the Univ of Ca Current Accepting new patients
Regents of the Univ of Ca CurrentSince Aug 22, 2018 Accepting new patients
Regents of the Univ of Ca Past Accepting new patients
Regents of the Univ of Ca Past Accepting new patients

Locations

643 W East Ave
Chico, CA 95926
Phone (530) 342-0502

3850 G St
Merced, CA 95340
Phone (209) 384-6528

2767 Olive Hwy
Oroville, CA 95966
Phone (916) 533-8500

4501 X St
Sacramento, CA 95817
Phone (916) 734-5959

4900 Broadway
Ste 2800
Sacramento, CA 95820
Phone (916) 734-9313

4860 Y St
Sacramento, CA 95817
Phone (916) 734-2700

4501 X St
Ste 3016
Sacramento, CA 95817
Phone (916) 734-3771

4501 X St
Fl 2
Sacramento, CA 95817
Phone (916) 734-5959

Organizations & group practices 5

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1172534400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1658361600000",
    "number": "1053448043",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4501 X ST STE 3016",
            "city": "SACRAMENTO",
            "state": "CA",
            "postal_code": "958172229",
            "telephone_number": "916-734-3772",
            "fax_number": "916-734-7946"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4501 X ST",
            "city": "SACRAMENTO",
            "state": "CA",
            "postal_code": "958172229",
            "telephone_number": "916-734-5959",
            "fax_number": "916-703-5265"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ROSS MANASHIL",
        "first_name": "KELLY",
        "middle_name": "K.",
        "name_prefix": "Ms.",
        "credential": "NP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2007-02-27",
        "last_updated": "2022-07-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "CA",
            "license": "12842",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "ACMC PROVIDER NUMBER",
            "identifier": "083477",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Sacramento, CA

Sources for this page

Verify at the official NPI Registry.